Successful modified combination of laparoscopic and endoscopic approaches to neoplasia with a non-exposure technique with semicircular seromuscular layer incision for gastric gastrointestinal stromal tumors near the cardia: a case report and video demonstration

Abstract

Background: Laparoscopic and endoscopic cooperative surgery (LECS) combines laparoscopic gastric resection and endoscopic techniques for local resection of gastric tumors, such as gastrointestinal stromal tumors (GIST), with minimal surgical margins. We describe a case that underwent a modified combination of laparoscopic and endoscopic approaches to neoplasia with a non-exposure technique (CLEAN-NET) approach, which is an LECS with a semi-circular seromuscular layer incision around the tumor to preserve the mucosal continuity, which acts as a barrier to avoid intraoperative tumor dissemination. Case presentation: A 43-year-old woman was referred to our hospital because of a gastric submucosal tumor near the cardia that was detected on medical examination. The patient was diagnosed with gastric GIST based on the results of endoscopic ultrasound-guided fine-needle aspiration. Modified CLEAN-NET was performed with a semicircular incision of the seromuscular layer on the opposite side of the cardia, making the surgical procedure simple and minimizing partial resection of the gastric wall, including the tumor, while preserving the cardia. The operative time was 147 min, the preoperative blood loss volume was 3 mL, and the postoperative hospital stay duration was 9 days. The resected specimen revealed a minimal resection of the gastric wall, including the tumor. The cardia and gastric nerves were preserved, and the postoperative food intake was good. Conclusions: The modified CLEAN-NET with semicircular seromuscular layer dissection is a simple and reliable surgical procedure for GIST near the cardia.